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2060 Pharmacology > Module 12 Cholesterol & Triglycerides > Flashcards

Module 12 Cholesterol & Triglycerides Flashcards

1
Q

Coronary Heart Disease

A
  • Coronary blood circulation
  • Fails to supply heart with blood
  • Caused by atherosclerosis
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2
Q

Atherosclerosis

A
  • Plaque build up in artery walls
  • Narrow arteries
  • Decrease flow to heart
  • Inflammatory process
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3
Q

Cholesterol Role

A
  • Cell membrane
  • Precursor of steroid hormones
  • Precursor of bile salts
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4
Q

Lipoprotein Structure

A
  • Phospholipid shell (hydrophilic)
  • Cholesterol & triglyceride core
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5
Q

Lipoprotein Function

A
  • Transport cholesterol & triglycerides into blood
  • Require lipoproteins for blood solubility
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6
Q

Apolipoproteins

A
  • Embedded in phospholipid shell
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7
Q

Apolipoprotein A-I

A
  • Transport cholesterol
  • Non-hepatic tissue to liver
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8
Q

Apolipoprotein B-100

A
  • Transport cholesterol to non-hepatic tissue
  • Bind & transfer triglyceride to cells
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9
Q

Apolipoprotein Functions

A
  • Recognition by cells bind/ingest lipoproteins
  • Activate metabolizing enzymes of lipoproteins
  • Increase stability of lipoproteins
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10
Q

Lipoprotein Classification

A
  • Based on density
  • High protein content = more dense
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11
Q

Very Low Density Lipoproteins (VLDL)

A
  • Deliver triglycerides for liver to fat/muscle
  • Triglyceride core
  • Majority of triglyceride in blood
  • Apolipoprotein B-100 molecule
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12
Q

Low Density Lipoproteins (LDL)

A
  • Deliver cholesterol to non-hepatic tissue
  • Cholesterol rich core
  • Apolipoprotein B-100 molecule
  • Increases coronary heart disease risk
  • Bad cholesterol
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13
Q

LDL Role in Atherosclerosis

A
  • Promote initiation
  • LDL move from blood to sub-endothelial space
  • Oxidation of LDL causes recruitment of monocytes
  • Convert to macrophages
  • Macrophages take up oxidized LDL
  • Create fatty streak, atherosclerotic lesion
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14
Q

Atherosclerotic Lesion

A
  • Lipid core
  • Tough fibrous plaque
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15
Q

High Density Lipoproteins (HDL)

A
  • Cholesterol back to liver, promote removal
  • Cholesterol core, minority of total
  • Decreases coronary heart disease risk
  • Apolipoproteins AI, AII, AIV
  • Good cholesterol
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16
Q

Cholesterol Testing Recommendations

A
  • Have diabetes
  • Have heart disease (includes fam history)
  • Have hypertension
  • Have central obesity
  • Smoke (includes recent cessation)
  • Inflammatory/renal disease
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17
Q

Cardiovascular Risk Assessment

A
  • Framingham risk score (FRS)
  • 10 year risk of developing coronary heart disease
  • Score above 20% high risk
  • Score below 10% low risk
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18
Q

Framingham Risk Assessment (FRS)

A
  • Age
  • Total blood cholesterol
  • Smoking
  • HDL cholesterol
  • Systolic blood pressure
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19
Q

Metabolic Syndrome

A
  • Combination of disorders (3+)
  • Increases risk of coronary heart disease
20
Q

Disorders Associated with Metabolic Syndrome

A
  • Central obesity
  • Elevated triglycerides
  • Low HDL cholesterol
  • Hyperglycemia
  • Hypertension
21
Q

Non-Drug Treatment of LDL

A
  • Diet
  • Weight control
  • Exercise
  • Cigarette smoking
22
Q

Diet

A
  • Decrease LDL cholesterol
  • Establish healthy body weight
  • Decrease cholesterol & saturated fat intake
23
Q

Weight Control

A
  • Lowers LDL cholesterol
  • Decreases coronary heart disease risk
  • Dietary & exercise modification
24
Q

Exercise

A
  • Decrease LDL cholesterol
  • Elevate HDL cholesterol
  • Decrease insulin resistance
  • Decrease blood pressure
  • 30-60 mins/day
25
Q

Cigarette Smoking

A
  • Decreases HDL cholesterol
  • Increases LDL cholesterol
26
Q

Elevated Lipid Treatment

A
  • Stains
  • Bile acid sequestrants
  • Nicotinic acid
  • Cholesterol absorption inhibitors
  • Fibric acid derivatives
27
Q

Cholesterol Synthesis

A
  • Majority occurs in liver
  • Mevalonic acid pathway
  • Greatest at night
28
Q

Mevalonic Acid Pathway

A
  • Acetyl CoA
  • HMG CoA
  • Mevalonic acid (HMG CoA reductase enzyme)
  • Multiple other products
  • Cholesterol
29
Q

Stains Actions

A
  • Decrease hepatic synthesis of cholesterol
  • Inhibit HMG CoA reductase enzyme
  • Upregulation of hepatic LDL receptors
  • Liver removes more cholesterol from blood
30
Q

Stains Benefits

A
  • Decrease LDL
  • Increase HDL
  • Decrease triglycerides
31
Q

Primary Prevention Studies

A
  • Prevent development of cardiovascular disease
  • Stains work as primary prevention
  • Decrease coronary events
32
Q

Secondary Prevention Studies

A
  • Prevent recurrence of cardiovascular events
33
Q

Atorvastatin

A
  • Low oral bioavailability
  • Majority absorbed by liver
  • Remaining distributed to spleen, adrenal glands, skeletal muscle
  • Metabolized by CYP3A4
  • Eliminated in feces
34
Q

Rosuvastatin

A
  • Low oral bioavailability
  • Majority absorbed by liver
  • Remaining distributed to skeletal muscle
  • Minimal metabolized
  • Eliminated in feces
  • Higher concentrations in Asians
35
Q

Adverse Effects of Stains

A
  • Muscle injury (myopathy)
  • Muscle Lysis (Rhabdomyolysis)
  • Hepatotoxicity
36
Q

Rhabdomyolysis Diagnosis

A
  • Measuring blood levels of creatine kinase enzyme
  • 10 times higher than normal
  • Increase in blood potassium
  • Acute kidney failure
37
Q

Nicotinic Acid (Niacin)

A
  • Inhibits hepatic secretion of VLDL & LDL
  • Increases HDL
38
Q

Nicotinic Acid Side Effects

A
  • Facial flushing
  • Hepatotoxicity
  • Hyperglycemia
  • Skin rash
  • Increase uric acid levels
39
Q

Bile Acid Sequestrants

A
  • Binding bile acids, prevent absorption
  • Increase demand for bile acid synthesis in liver
  • Require LDL, increase number of receptors
  • Increase cholesterol uptake to liver
  • Decrease plasma LDL levels
40
Q

Action of Bile Acid Sequestrants

A
  • Binding bile acids, prevent absorption
  • Increase demand for bile acid synthesis in liver
  • Require LDL, increase number of receptors
  • Increase cholesterol uptake to liver
  • Decrease plasma LDL levels
41
Q

Adverse Effects of Bile Acid Sequestrants

A
  • Not absorbed, no side effects
  • Constipation & bloating
  • Decrease drug absorption (digoxin, warfarin, antibiotics)
42
Q

Cholesterol Absorption Inhibitors

A
  • Inhibit NPC1L1, ezetimibe with a statin
  • Vytorin
43
Q

Ezetimibe Function

A
  • Decrease intestinal absorption
  • Lower LDL
  • Increase hepatic synthesis
44
Q

Fibric Acid Derivatives (Fibrates)

A
  • Decrease plasma triglycerides
  • Increase HDL
  • Increase lipoprotein lipase activity
45
Q

Action of Fibrates

A
  • Binding & activating PPARa receptor in liver
46
Q

PPAra Activation

A
  • Increase lipoprotein lipase synthesis
  • Decrease apolipoprotein C-III
  • Increase apolipoprotein A-I
47
Q

Adverse Effects of Fibrates

A
  • Increase risk of gallstones
  • Myopathy
  • Hepatotoxicity

2060 Pharmacology (18 decks)

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